Differences in Sources Suggest RI Does in Fact Have Most Burdensome Mandates

Admittedly, I’ve been griping about PolitiFact from the sidelines almost since it entered the field. For many of the uses that the reporters put it toward, the notion of entirely objective facts is as absurd as the notion of entirely objective reporters. The simplistic (albeit marketable) Truth-o-Meter emphasizes the point; something’s being arguable is not the same as its being partially false.

My vantage point was backstage during production of PolitiFact RI’s investigation of RI Center for Freedom & Prosperity CEO Mike Stenhouse’s statement about health care mandates in Rhode Island, and I can’t say I’ve had my concerns about fairness eased.

According to the Center’s Competitiveness Report Card, Rhode Island has the greatest number of mandates in the country. In an op-ed in the Providence Journal, Stenhouse characterized it as “the most burdensome level.” And PolitiFact reporter Gene Emery went on the hunt.

Emery agreed that the data, from the Council for Affordable Health Insurance (CAHI), was accurate, inasmuch as the appropriate officials in Rhode Island confirmed that every item it called a mandate was indeed to be found in state law. But then he found a list of mandates compiled by Blue Cross and Blue Shield that had fewer mandates and ranked Rhode Island in the teens for all states. (The two rankings used to appear side by side on this page, but the table has conspicuously disappeared, along with the footnote that used to reference the Blue Cross study. Oddly, a number 1 still marks the line on which the footnote was.)

The PolitiFact page for the issue notes that Emery exchanged emails with Kelly Miller, a Blue Cross spokeswoman, but I managed to speak with the woman who authored the study and has been maintaining the list for a quarter century, Susan Laudicina. She seemed very surprised that I was able to track her down but was thorough and helpful in comparing the two lists to explain the difference in methodology. CAHI, she discovered, counted things as separate mandates that she grouped together. Examples that she gave were diabetes education and diabetes treatment and requirements for coverage treating specific diseases. Often these separate mandates appear within the same statute, she told me.

So the question is: Which definition of mandate is more appropriate when comparing states? I’d offer two suggestions.

First, the very fact that the two listings differ suggests that the more appropriate one to use for the Center’s purposes is the more granular one — the CAHI report. Obviously, for Rhode Island to fall so far in the Blue Cross ranking, it must require detailed coverage that other states do not. The fact that those other states may have mandates in more categories doesn’t change that reality. One hotel may offer television, spa, and in-room refrigerator services, while another adds complimentary toothpaste. But if the one without the toothpaste has the advantage of providing satellite TV channels, full-body massages, and several meals’ worth of food in the fridge, it would be suspicious to argue that Toothpaste Inn offers more.

Second (and in the same line), the CAHI report put a cost on each mandate. The numbers come in fairly broad ranges, to be sure, but the Ocean State leads by any measure, imposing an increase in health insurance costs of between 33.1% and 115.9%. Combining more than one of CAHI’s mandates doesn’t make the price tag go away, and Laudicina told me that her Blue Cross report doesn’t go to the extent of pricing each imposed requirement.

It’s possible that another state’s mix of mandates could exceed Rhode Island’s premium within that broad range. However, much of its lead has to do with its being one of only four states that mandates prescription drugs, according to CAHI. That is one of only two mandates that increases costs in the range of 5-10%. Even by Blue Cross’s list, none of the others (Pennsylvania, Vermont, and Washington) match RI for number of mandates.

Given all of this, it is accurate (i.e., true) to say that Rhode Island has the greatest number of required services, measured at the level of greatest detail. It is also highly probable that these mandates drive up prices more than in any other state. Indeed, to the extent that mandates discourage insurers from operating here, leaving Rhode Islanders with their mere three choices, the cost of diminished competition could be even greater.

The RI Center for Freedom & Prosperity will be revising its report card for the new year, and if anything, this exercise with PolitiFact has strengthened my plans to use the CAHI report as the basis for claims about health insurance mandates. If Rhode Islanders want to keep talking away the real damage that the local ruling class is doing to their lives, well, that’s up to them.

If the assertion is only half true, how does PolitiFact explain the marked lack of competition by health care companies in this state? The two biggest carriers in the state are Blue Cross and United, while Tufts has edged into a small corner of the market.

And in fact, for individual coverage, there is zero competition because only one company (Blue Cross) offers such coverage.